Hospital heart attack death rates improving but very elderly still missing out

October 19th, 2011 in Cardiology /

Despite substantial reductions in the hospital death rates for heart attack patients across all age groups, there are still worrying inequalities in heart attack management for the elderly, a new study has shown.

The research, carried out by the University of Leeds, UK and funded by the British Heart Foundation, showed that the risk of a heart patient dying in hospital almost halved across all age groups between 2003 and 2010. Specialist treatments  such as coronary angioplasty  to open blocked or narrowed arteries that supply blood to the heart are also much more widely available to heart attack patients now.

But patients aged 85 or over are less likely than other age groups to receive specialist care from a cardiologist and vital heart medicines upon discharge from hospital.

The study found that heart attack patients who are over 85 years old are 75 per cent less likely than someone under 55 to receive emergency coronary angioplasty or clot-busting drugs. These treatments restore blood to the oxygen-starved part of the heart. Patients over 85 were also considerably less likely to receive vital heart drugs such as beta blockers and statins after treatment for a heart attack.

The improvements in specialist care are evidence of the impact of the National Service Framework for Coronary Heart Disease (NSF CHD). The framework has been crucial in providing a focus for the health service in reducing death and disability caused by heart disease in England and Wales. However the results also highlight the unequal access to heart care across different age groups.

The researchers used data recorded in the Myocardial Ischemia National Audit Project, which examined the quality of management of heart attacks across hospitals in England and Wales. The data is drawn from over 600,000 heart attack events at 255 hospitals.

Dr Chris Gale, NIHR Clinician Scientist at the University of Leeds, UK and Consultant Cardiologist, who led the research, said: "The NSF has led the NHS to make great strides in heart attack treatment by ensuring the best proven treatments are available to heart patients across England and Wales.

"But as the results for the elderly show, despite dramatic improvements in their care, we shouldn't be complacent. There's still progress to be made, not just in-hospital but after patients are discharged and a GP is then responsible for their care."

Natasha Stewart, Senior Cardiac Nurse at the British Heart Foundation, said: "This study highlights the importance of providing the best possible care to all heart patients regardless of their age. It's not fully clear why the over 85s are missing out but it's wholly unacceptable that elderly heart attack patients do not have equal access to a cardiologist in the UK. This reduces their chance of getting early interventions, even though there's evidence that they would benefit just as much as younger patients.

"The NSF has clearly helped to improve and standardise treatment and care for heart attack patients. But the continued inequalities demonstrated in this study  combined with the fact that coronary heart disease is still the UK's single biggest killer  emphasises the need for a renewed approach to address the huge future challenges we face."

More information: The study, CP Gale et al, 'Resolving inequalities in care? Reduced mortality in the elderly after acute coronary syndromes. The Myocardial Ishcaemia National Audit Project 2003-2010', is published online in the European Heart Journal (doi:10.1093/eurheartj/ehr381).